The Medullary syndromes , Diseases or injuries of the spinal cord, are a heterogeneous set of pathologies that affect this structure.
These syndromes are uncommon. However, they cause severe sequelae that lead to a significant disability. That is why early diagnosis is essential to start the treatment as soon as possible.
The spinal cord Is part of Central Nervous System And goes from the Medulla bulb of the brain To the lumbar region. Its main function is to exchange information between the brain and the rest of the organism, through ascending and descending nerve fibers.
The main functions of the spinal cord are the perception of touch, vibrations, pressure, pain and temperature. In addition to producing movements, and proprioception (feel our own body components). It also controls the bladder, bowel and basic sexual functions.
Each part of the spinal cord corresponds to a function and place of the body. Thus, if a spinal cord syndrome encompasses a certain area of the spinal cord, only the legs, hands, or chest down can be affected, for example.
The medullary syndromes can occur at any level of the spinal cord, producing symptoms from the damaged area down.
These syndromes are also often classified as traumatic (due to trauma) or myelopathies (marrow disorders that are not due to trauma).
Another distinction that is made of the medullary syndromes is if they are complete or incomplete. The former encompass a whole segment of the cord, while the latter only damage a part of the cord.
Types of spinal syndromes
Here are the different spinal syndromes. I explain the symptoms, causes and location of the damages of each one of them; As well as its prognosis.
Complete condition of the spinal cord
It is a complete spinal cord injury, in which all functions below the damage are lost.
Thus, both corticospinal (motor), spinothalamic (touch, pain and temperature) and dorsal (pressure, vibration or proprioception) functions are interrupted. The symptoms are flaccid paralysis, total anesthesia, and absence of reflexes below the lesion. In addition to loss of urinary and intestinal control, and sexual dysfunction.
The prognosis is usually negative, with high mortality rates and few chances of recovery.
It may appear due to trauma, heart attacks, tumors, abscesses, or transverse myelitis . The latter is a neurological disorder that causes complete inflammation in a segment of the spinal cord.
This inflammation can destroy the Myelin , An insulating substance essential for nerve transmission. Symptoms can last from hours to weeks.
Anterior medullary syndrome
It involves damage to the front of the spinal cord or decreased blood flow to the anterior spinal artery. It is usually due to heart attacks, fractures, vertebral dislocations or disc hernias.
It produces a total motor deficit below the level of the injury. Motor function, pain perception and temperature are lost. Touch, vibration and Proprioceptive.
However, the symptoms may vary depending on whether the injured area is more localized or wider. Their prognosis is usually poor, as only 10 to 20% recover.
Central or centromedullary medullary syndrome
It is the most frequent and is usually due to an injury that affects the cervical spinal cord. It is a lesion in the gray matter of the interior of the marrow.
Weakness is noted mainly in the upper extremities (arms), as well as lack of sensitivity to pain, touch, temperature and pressure below the level of the lesion. It also produces dysfunction of the bladder, in particular, urinary retention.
Its most common causes are Syringomyelia Or cyst within the spinal cord, hyperextension or flexion of the neck due to falls, vehicle accidents, blows or Spinal stenosis.
Posterior medullary syndrome
It assumes less than 1% of all injuries due to trauma. Only the dorsal columns are affected and mainly affects the sensitivity, but not the functionality.
That is, these patients can walk, feel the pain and the temperature. But they can not perceive vibrations below the level of the injury and proprioception is lost.
It may arise from untreated syphilis, occlusion of the posterior spinal artery, Friedreich's ataxia Or degeneration of the bone marrow due to lack of b12 vitamin .
Brown Sequard Syndrome
It is uncommon, representing between 1 and 4% of all spinal cord injuries due to trauma. It occurs when one half of the marrow is injured or affected, or hemisected.
It causes a series of symptoms in the same half of the body where the injury has occurred: loss of motor function, of proprioception, sensation of touch and vibration. While on the opposite side (contralateral to the injury), there is loss of sensation of pain and temperature.
Usually it is the product of wounds in a single side of the marrow by firearms or white arms (penetrating trauma). Or it may be due to fracture of vertebrae or tumors.
Spinal cord syndrome
It consists of damage at the end of the spinal cord, around the lumbar nerves L1. Nerve roots emerging from this area are called"horsetail"and if affected are called"equine tail syndrome", although it is not a spinal syndrome in itself.
They can both be injured because of their proximity. Its usual causes are physical trauma, ischemia and tumors.
This zone has spinal segments S4 and S5, which control the bladder, bowel and certain sexual functions.
Therefore, alterations in the functioning of the bladder may occur, such as retention, increased urinary frequency or incontinence. In addition to reduced muscle tone in the anal sphincter, fecal incontinence, erectile dysfunction , Variable weakness of the lower extremities, etc. There is also a loss of perianal and perineal sensitivity called"saddle anesthesia".
If only the"ponytail"nerves are affected, the symptoms are very similar, but with weakness, paralysis or pain On one side of the body. Equine cauda syndrome is usually due to fracture of an intervertebral disc or to a tumor.
The latter has a better prognosis than the medullary cone syndrome, since the peripheral nervous system Recovers more easily than the central one.
References
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- Naranjo, I. C., Gómez, J. M., Sevilla, R. R., & Cuenca, J. P. (2015). Diseases of the spinal cord. Medullary syndromes. Medicine-Continued Medical Training Program Accredited, 11 (78), 4667-4677.
- Rubin, M. (s.f.). Overview of Spinal Cord Disorders. Retrieved on April 4, 2017, from MSD Manual: msdmanuals.com.
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